Survey of female gynecologic oncologists and fellows: balancing professional and personal life

Parenthood and neurosurgery in Europe a white paper from the European Association of Neurosurgical Societies' Diversity in Neurosurgery Committee Part I - Family Planning and Practice during Pregnancy

Introduction

Family and work have immensely changed and become intertwined over the past half century for both men and women. Additionally, alongside to traditional family structures prevalent, other forms of families such as single parents, LGBTQ + parents, and bonus families are becoming more common. Previous studies have shown that surgical trainees regularly leave residency when considering becoming a parent due to the negative stigma associated with pregnancy during training, dissatisfaction with parental leave options, inadequate lactation and childcare support, and desire for greater mentorship on work-life integration. Indeed, parenthood is one of the factors contributing to attrition in surgical specialities, neurosurgery not being an exception.

Research question

The Diversity in Neurosurgery Committee (DC) of the European Association of Neurosurgical Societies (EANS) recognizes the challenges individuals face in parenthood with neurosurgery and wishes to address them in this white paper.

Materials and methods

In the following sections, the authors will focus on the issues pertaining to family planning and neurosurgical practice during pregnancy in itemized fashion based on an exhaustive literature search and will make recommendations to address the matters raised.

Results

Potential solutions would be to further improve the work-family time ration as well as improving working conditions in the hospital.

Discussion and conclusion

While many obstacles have been quoted in the literature pertaining to parenthood in medicine, and in neurosurgery specifically, initiatives can and should be undertaken to ensure not only retention of colleagues, but also to increase productivity and job satisfaction of those seeking to combine neurosurgery and a family life, regardless of their sexual identity and orientation.

Pregnancy in physicians: A scoping review

BACKGROUND

The personal health and professional impact of physician pregnancy requires further study. We performed a comprehensive scoping review of physician pregnancy to synthesize and assess the evidence to aid decision-making for relevant stakeholders.

METHODS

A search of 7 databases resulted in 3733 citations. 407 manuscripts were included and scored for evidence level. Data were extracted into themes using template analysis.

RESULTS

Physician pregnancy impacted colleagues through perceived increased workload and resulted in persistent stigmatization and discrimination despite work productivity and academic metrics being independent of pregnancy events. Maternity leave policies were inconsistent and largely unsatisfactory. Women physicians incurred occupational hazard risk and had high rates of childbearing delay, abortion, and fertility treatment; obstetric and fetal complication rates compared to controls are conflicting.

CONCLUSIONS

Comprehensive literature review found that physician pregnancy impacts colleagues, elicits negative perceptions of productivity, and is inadequately addressed by current parental leave policies. Data are poor and insufficient to definitively determine the impact of physician pregnancy on maternal and fetal health. Prospective risk-matched observational studies of physician pregnancy should be pursued.

Challenges and Solutions for Physician Mothers: A Critical Review of the Literature

Physician mothers face unique challenges related to family planning, pregnancy, childcare, work-life integration, inequities, and biases that may have serious widespread implications. There is a paucity of available information on the extent and ramifications of such challenges and related solutions. The purpose of this critical review of the literature was to identify and summarize challenges and solutions pertaining to physician mothers. A comprehensive literature search of databases (PubMed, CINAHL, EBSCO MegaFILE, and APA PsycInfo on Ovid) from January 1, 2008, to December 31, 2018, identified empirical articles that addressed challenges, policies, or solutions specific to physician mothers. Search terms included: physician, doctor, surgeon, specialist, hospitalist, pediatrician, woman, female, gender, mom, mother, maternity, breastfeed, pregnant, baby, infant, parent, parenthood, child,bias, status, stigma, inequity, discrimination, equal, unequal, justice, childcare, daycare, babysit, and nanny in various combinations. Seventy-one articles met inclusion criteria and were analyzed to identify categories and themes related to challenges and solutions for physician mothers. Themes for challenges were categorized by level of influence (individual, organizational and health care system, and societal); themes for solutions were categorized by approach and intervention (mentorship, childbearing and child-rearing support, addressing barriers to career satisfaction and work-life integration, and identification and reduction of maternal bias in medicine). Physician mothers face challenges that have negative implications for individuals, organizations and the health care system, and society. Clear understanding of associated challenges and potential solutions is a critical first step to address biases and barriers affecting physician mothers.

Differences in Family Planning and Fertility Among Female and Male Gynecologic Oncologists

Background: The objective of the study was to compare family planning and infertility among female and male gynecologic oncologists in the United States

Methods: This cross-sectional multiple choice survey was administered to the Society of Gynecologic Oncology gynecologic oncologists. The survey collected information on demographics and practice, family planning, and fertility and infertility experiences. Chi-square and Fisher's exact tests were used to compare experiences by gender.

Results: Two hundred eighteen of 1243 (18%) members responded to the survey. The majority were women (71%), Caucasian (78%), and had been practicing fewer than 10 years (56%). One-third (32%) were 35+ years of age at the birth of their first child, and 67% delayed childbearing due to their career. Women were more likely than men to report career choice-influenced family planning. Just under half (44%) expressed current or past concerns about fertility, and this was more prevalent among women; 81% had sought infertility counseling. Among respondents who had fertility struggles, almost half (45%) reported their colleagues were unaware. Forty percent felt their fertility concerns affected work life, and 13% felt stigmatized for their fertility struggles.

Conclusions: These findings suggest that a career in gynecologic oncology have an impact on family planning, often resulting in childbearing delays and infertility concerns, especially among women. Support for our colleagues struggling with infertility should be included in wellness initiatives.

Factors Associated With Residency and Career Dissatisfaction in Childbearing Surgical Residents

Importance

Previous work shows women who have children during surgical residency face difficulty balancing childbearing with training, which negatively affects residency and career satisfaction. Little is known about the factors that drive professional discontent.

Objective

To determine factors associated with professional dissatisfaction for childbearing residents.

Design, Setting, and Participants

Self-administered survey questionnaire electronically distributed through the Association of Program Directors in Surgery, the Association of Women Surgeons, and targeted Twitter and Facebook platforms. The survey was distributed in January 2017 to surgeons who delivered at least 1 child during a US general surgery residency and was available online for 4 weeks.

Main Outcomes and Measures

Respondents were reported to be dissatisfied with their residency if they indicated agreement that they considered leaving residency owing to challenges surrounding childbearing (considered leaving). Respondents were reported to be unhappy with their career if they indicated agreement with statements that (1) given an opportunity to revisit their job choice, they would choose a nonsurgical career more accommodating of motherhood (revisit career choice) or (2) they would advise a female medical student against a surgical career owing to difficulties balancing motherhood with the profession (advise against surgery). Logistic regression was used to determine predictors of agreement with each of the 3 statements of professional dissatisfaction.

Results

In total, 347 women responded to the survey and reported 452 pregnancies, and the mean (SD) age was 30.5 (2.7) years. One hundred seventy-nine respondents (51.6%) agreed with at least 1 statement of residency or career dissatisfaction. Lack of a formal maternity leave policy was associated with "considered leaving" (odds ratio [OR], 1.83; 95% CI, 1.07-3.10). Perception of stigma during pregnancy was associated with "revisit career choice" (OR, 1.79; 95% CI, 1.01-3.19). Changing fellowship plans owing to perceived difficulty balancing motherhood with the originally chosen subspecialty was associated with all 3 markers of residency and career dissatisfaction ("considered leaving" OR, 2.68; 95% CI, 1.30-5.56; "revisit career choice" OR, 2.23; 95% CI, 1.13-4.43; and "advise against surgery" OR, 2.44; 95% CI, 1.23-4.84).

Conclusions and Relevance

Surgery residents who perceived stigma during pregnancy, did not have a formal institutional maternity leave policy, or altered their fellowship training plans because of challenges of childbearing expressed greater professional dissatisfaction. Mentorship in subspecialty selection and work-life integration, interventions to reduce workplace bias, and identification of obstacles to establishment of maternity leave policies are needed to enhance professional fulfillment for childbearing residents.

Descriptive review of junior OB/GYN physicians' work task financial compensation in German hospitals

Beginning in the first decade of the 21st centruy, there was a growing disregard for the benefits of the German medical system concerning the junior obstetricians/gynecologists (OB/GYN) job situation. As in other fields of medicine, numerous colleagues left Germany to work in other countries such as the United Kingdom, Noway, Sweden, or Switzerland. According to studies, financial factors represent one of the reasons for the discontent. We here present a practical descriptive approach to assess/review the actual compensation of single work tasks of OB/GYNs on the basis of previously published, existing data. Using the workflow data from the Medical work Assessment in German hospitals (MAGRO) platform of twenty junior OB/GYNs with an average workday of 9:24:35 h (SD = 01:05:07 h), a large scale data analysis of 2,325,556 different time points was performed to calculate the financial valuation of single work tasks. In order to assess the evolution over the past years, different modern and historic (e.g. AiP) pay scales were used and analysed in relation to the actual work on a weekly, monthly and per annum basis. Our review shows that there has been a dramatic increase in the financial reward of the practical work tasks of junior OB/GYN physicians in German hospitals in comparison to the situation of the early 2000s years. In this respect, it can not be further argued that the German system has large disadvantages concerning the payment of junior doctors in comparison to other European countries.

Evaluation of satisfaction with work-life balance among U.S. Gynecologic Oncology fellows: A cross-sectional study

To characterize the state of satisfaction with work–life balance (WLB) among gynecologic oncology fellows in training, risk factors for dissatisfaction, and the impact of dissatisfaction on career plans. A cross-sectional evaluation of gynecologic oncology fellows was performed using a web-based survey. Demographic data, fellowship characteristics, and career plans were surveyed. The primary outcomes were satisfaction with WLB and career choices. p < 0.05 was used as a test for significance. Regression analysis was used to estimate prevalence ratios (PRs) for various potential risk factors for dissatisfaction. Of 52.5% responding fellows, 22.2% were satisfied with WLB, but 83.3% would be physicians again and 80.3% would select gynecologic oncology again. Satisfaction with WLB was significantly associated with age (PR = 0.70, 95% CI: 0.54–0.91), working fewer than 80 h per week (PR = 4.35, 95% CI: 1.34–14.10), and fatigue (PR = 0.31, 95% CI: 0.12–0.75). Career and WLB satisfaction were not associated with gender, marital status, and whether or not the fellow is a parent. Those satisfied with WLB planned to work an average of 3.5 years longer than those who were not (p < 0.05). Gynecologic oncology fellows are not generally satisfied with their WLB, although this does not alter their overall career or specialty satisfaction. Satisfaction with WLB predicts a longer post-fellowship career. Further studies are needed to determine the workforce impact of this lack of perceived balance.

•

Most gynecologic oncology fellows are not satisfied with their work–life balance.

•

Working 80 h per week or more predicts dissatisfaction with work–life balance.

•

Satisfied fellows plan to work 3.5 years longer than those who are not satisfied.

Academic women faculty: are they finding the mentoring they need?

BACKGROUND

Although women comprise an increasing proportion of US medical school faculty, they are underrepresented at higher ranks. Lack of effective mentoring may contribute to this disparity. We examined the role of academic rank, research focus, parenting, and part-time work on mentoring importance, needs, and gaps.

METHODS

In 2009, women faculty members of Harvard Medical School and Harvard School of Dental Medicine were invited by e-mail to participate in a 28-item structured questionnaire. Descriptive statistics and adjusted logistic regressions were used to identify relevant themes.

RESULTS

Of the 1179 women faculty who responded, 54% had a mentor, and 72% without a mentor desired mentoring. The most important mentor characteristic identified was availability. Respondents endorsed most mentoring areas as important (range 51%-99%); 52% of respondents identified mentoring gaps (area important and unmet) in developing and achieving career goals and negotiation skills. Interest in mentorship for skills needed for advancement (research and lecturing skills and getting national recognition) was significantly associated with lower rank. Assistant professors were most likely to identify mentoring related to writing and publishing articles, whereas associate professors identified program development/strategic planning as important. Faculty who are parents identified gaps in finding collaborators and balancing work and family life.

CONCLUSIONS

This survey identified a desire for both comprehensive and targeted mentoring to address gaps that varied by faculty rank, research focus, parenting, and work time status. Strategies to enhance mentoring should address career stages and include a structured framework for assessing mentoring gaps.

Observation and analysis of junior OB/GYNs' workflow in German hospitals

PURPOSE

Over the past few years the numbers of German physicians choosing to work abroad or leaving the medical profession have been growing. Main reasons for physicians' dissatisfaction are the lack of autonomy and the subsequent workload. Studies have employed subjective instruments of evaluation to investigate levels of occupational stress. However, there is a lack of objective work task analysis. The aim of this study is to monitor the workflow of German obstetrician/gynecologists (OB/GYN) through an objective, computer-based analysis.

METHODS

From 10/08 to 02/09 twenty OB/GYNs in three hospitals in Berlin were monitored (n=19 females, n=1 male, age 23-38 years). Each one of them was accompanied throughout three entire workdays.

RESULTS

The junior physicians' average workday lasted 9:24:35 h (SD=01:05:07 h). During this time period, they spent an average of 02:41:56 h/day (SD=00:33:35 h) on internal communication (28.68%). On average 01:19:11 h (SD=00:55:15 h) were spent in the operating room (14.03%). An average total of 5:38:28 h (SD=00:11:22 h) were spent attending to indirect patient.

CONCLUSIONS

The workflow is disorganized and full of interruptions, which could cause medical errors. Improving the physicians' work environment will likely require a reorganization of medical processes.

The generation and gender shifts in medicine: an exploratory survey of internal medicine physicians

Background

Two striking demographic shifts evident in today's workforce are also apparent in the medical profession. One is the entry of a new generation of physicians, Gen Xers, and the other is the influx of women. Both shifts are argued to have significant implications for recruitment and retention because of assumptions regarding the younger generation's and women's attitudes towards work and patient care. This paper explores two questions regarding the generations: (1) How do Baby Boomer and Generation X physicians perceive the generation shift in work attitudes and behaviours? and (2) Do Baby Boomer and Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance? Gen Xers include those born between 1965 and 1980; Baby Boomers are those born between 1945 and 1964. We also ask: Do female and male Generation X physicians differ significantly in their work hours and work attitudes regarding patient care and life balance?

Methods

We conducted exploratory interviews with 54 physicians and residents from the Department of Medicine (response rate 91%) and asked about their perceptions regarding the generation and gender shifts in medicine. We limit the analyses to interview responses of 34 Baby Boomers and 18 Generation Xers. We also sent questionnaires to Department members (response rate 66%), and this analysis is limited to 87 Baby Boomers' and 65 Generation Xers' responses.

Results

The qualitative interview data suggest significant generation and gender shifts in physicians' attitudes. Baby Boomers generally view Gen Xer physicians as less committed to their medical careers. The quantitative questionnaire data suggest that there are few significant differences in the generations' and genders' reports of work-life balance, work hours and attitudes towards patient care.

Conclusion

A combined qualitative and quantitative approach to the generation shift and gender shift in medicine is helpful in revealing that the widely held assumptions are not necessarily reflective of any significant differences in actual work attitudes or behaviours of Boomer and Gen X physicians or of the younger generation of women entering medicine.

Mentorship and productivity among gynecologic oncology fellows

BACKGROUND

To identify factors that enable gynecologic oncology fellows to achieve goals set by the American Board of Obstetrics and Gynecology (ABOG).

METHOD

Survey questions identified demographics, mentorship status, productivity, career plans, and opinions in a fourth fellowship year.

RESULTS

Reasons cited for choosing specific programs were academic reputation, faculty, geographic location, and research opportunities. Two thirds identified a clinical or basic science mentor. There was an association between having a research mentor and expectation for completing one's thesis (p = 0.002).

CONCLUSION

Achieving goals set by ABOG may be related to the presence of a research mentor.